CPT 43334 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Surgery • Surgical Procedures on the Digestive System |
| Common Place of Service | • 21 - Inpatient Hospital • 22 - On Campus Outpatient Hospital |
| Common Modifiers | • None • GC - Service performed by resident under supervision • AS - PA/NP/CNS assistant at surgery |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 43334 |
National average reimbursement for CPT 43334 by major payers:
$1,615.58
$1,764.28
$1,739.28
$2,089.94
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 43334 | ||||||
United | 43334 | $850.00 | 1841255718 - PAOLI SURGERY CENTER LLC | 621547618 - (PA) PAOLI SURGERY CENTER LLC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $450.00 | 1194966051 - FIRST STREET SURGERY CENTER INC. | 263375664 - (CA) FIRST STREET SURGERY CENTER INC | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $1064.00 | 1740328947 - ENDOSCOPY CONSULTANTS, LLC | 510425612 - (GA) ENDOSCOPY CONSULTANTS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $417.00 | 1467582437 - NORTH FLORIDA SURGERY CENTER INC, NORTH FLORIDA SURGERY CENTER | 593377918 - (FL) NORTH FLORIDA SURGERY CENTER INC | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $380.00 | 1043204688 - INDIANA AMBULATORY SURGICAL ASSOCIATES, INC | 232923182 - (PA) INDIANA AMBULATORY SURGICAL ASSOCIATES INC | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $100.00 | 1073579256 - OUTPATIENT SURGICAL CARE LTD | 860525610 - (AZ) OUTPATIENT SURGICAL CARE LTD | AZ | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $969.00 | 1508135658 - SURGERY CENTER OF ATHENS LLC | 450581955 - (GA) SURGERY CENTER OF ATHENS LLC | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $350.00 | 1548235963 - THE SCRANTON PA ENDOSCOPY ASC LP, THE SCRANTON ENDOSCOPY CENTER | 202853361 - (PA) THE SCRANTON PA ENDOSCOPY ASC LP | PA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $1336.00 | 1447269790 - WEST BEND SURGERY CENTER LLC | 391954169 - (WI) WEST BEND SURGERY CENTER LLC | WI | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $626.00 | 1376513440 - FLORIDA EYE CLINIC AMBULATORY SURGERY CENTER, INC. | 592303141 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $641.00 | 1326549676 - CHATHAM ORTHOPAEDIC ASC, LLC, CHATHAM ORTHOPAEDIC SURGERY CENTER | 824075002 | GA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $1200.00 | 1720129893 - PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER | 330898866 | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $1188.00 | 1598927147 - MORTON PLANT MEASE HEALTH SERVICES INC, BARDMOOR OUTPATIENT CENTER | 204385452 | FL | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $405.00 | 1386616050 - INDEPENDENCE ASC LLC, THE ENDOSCOPY CENTER - NORTH | 621707564 | MO | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 43334 | $2280.00 | 1215930078 - MARIN HEALTH VENTURES, LLC, MARIN SPECIALTY SURGERY CENTER | 943377073 - (CA) MARIN HEALTH VENTURES, INC. DBA MARIN SPECIALTY SURGERY CENTER | CA | Ambulatory Surgical Clinic/Center (261QA1903X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 43334 vs. Other Surgical Procedures on the Digestive System Codes
The CPT 43334 code is part of the Surgery services used for Surgical Procedures on the Digestive System. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 43334 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 43333-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Laparotomy, Except Neonatal; With Implantation Of Mesh Or Other Prosthesis |
| 43334-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracotomy, Except Neonatal; Without Implantation Of Mesh Or Other Prosthesis |
| 43335-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracotomy, Except Neonatal; With Implantation Of Mesh Or Other Prosthesis |
| 43336-CPT | High | Once Per Dos Repair, Paraesophageal Hiatal Hernia (Including Fundoplication), Via Thoracoabdominal Incision, Except Neonatal; Without Implantation Of Mesh Or Other Prosthesis |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 43334. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 43334 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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